1
|
Giannakopoulos K, Kavadella A, Aaqel Salim A, Stamatopoulos V, Kaklamanos EG. Evaluation of the Performance of Generative AI Large Language Models ChatGPT, Google Bard, and Microsoft Bing Chat in Supporting Evidence-Based Dentistry: Comparative Mixed Methods Study. J Med Internet Res 2023; 25:e51580. [PMID: 38009003 PMCID: PMC10784979 DOI: 10.2196/51580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/15/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The increasing application of generative artificial intelligence large language models (LLMs) in various fields, including dentistry, raises questions about their accuracy. OBJECTIVE This study aims to comparatively evaluate the answers provided by 4 LLMs, namely Bard (Google LLC), ChatGPT-3.5 and ChatGPT-4 (OpenAI), and Bing Chat (Microsoft Corp), to clinically relevant questions from the field of dentistry. METHODS The LLMs were queried with 20 open-type, clinical dentistry-related questions from different disciplines, developed by the respective faculty of the School of Dentistry, European University Cyprus. The LLMs' answers were graded 0 (minimum) to 10 (maximum) points against strong, traditionally collected scientific evidence, such as guidelines and consensus statements, using a rubric, as if they were examination questions posed to students, by 2 experienced faculty members. The scores were statistically compared to identify the best-performing model using the Friedman and Wilcoxon tests. Moreover, the evaluators were asked to provide a qualitative evaluation of the comprehensiveness, scientific accuracy, clarity, and relevance of the LLMs' answers. RESULTS Overall, no statistically significant difference was detected between the scores given by the 2 evaluators; therefore, an average score was computed for every LLM. Although ChatGPT-4 statistically outperformed ChatGPT-3.5 (P=.008), Bing Chat (P=.049), and Bard (P=.045), all models occasionally exhibited inaccuracies, generality, outdated content, and a lack of source references. The evaluators noted instances where the LLMs delivered irrelevant information, vague answers, or information that was not fully accurate. CONCLUSIONS This study demonstrates that although LLMs hold promising potential as an aid in the implementation of evidence-based dentistry, their current limitations can lead to potentially harmful health care decisions if not used judiciously. Therefore, these tools should not replace the dentist's critical thinking and in-depth understanding of the subject matter. Further research, clinical validation, and model improvements are necessary for these tools to be fully integrated into dental practice. Dental practitioners must be aware of the limitations of LLMs, as their imprudent use could potentially impact patient care. Regulatory measures should be established to oversee the use of these evolving technologies.
Collapse
Affiliation(s)
| | - Argyro Kavadella
- School of Dentistry, European University Cyprus, Nicosia, Cyprus
| | - Anas Aaqel Salim
- School of Dentistry, European University Cyprus, Nicosia, Cyprus
| | - Vassilis Stamatopoulos
- Information Management Systems Institute, ATHENA Research and Innovation Center, Athens, Greece
| | - Eleftherios G Kaklamanos
- School of Dentistry, European University Cyprus, Nicosia, Cyprus
- School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| |
Collapse
|
2
|
Elkady DM, Khater AGA. Knowledge and attitudes toward evidence-based cariology and restorative dentistry among Egyptian dental practitioners: a cross-sectional survey. BMC Oral Health 2023; 23:622. [PMID: 37658399 PMCID: PMC10474780 DOI: 10.1186/s12903-023-03333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND This is the first study to assess Egyptian dental practitioners' knowledge about conservative caries management approaches and investigate whether this knowledge transfers into clinical practice and the barriers to translating research into evidence-based practice. METHODS A sample of dental practitioners was surveyed using an online questionnaire. Convenience and snowball sampling were used to collect data from February to June 2022. We included graduated dentists from Egyptian universities who practiced in Egypt. Data were analyzed with descriptive statistics, and the associations between variables were checked using Kruskal Wallis and Chi-Square tests. RESULTS This study included 396 participants from throughout Egypt. There were significant correlations between specialty and participants' knowledge and behaviors toward evidence-based caries management (p = 0.002) and between specialization and tools used to detect carious lesions (p < 0.001). Most participants (59.1%) used G.V Black's classification, and (80.8%) removed caries based on the feature of dentin hardness and color, whereas (67%) removed caries until hard dentine remained. The participants' primary hurdle to staying up-to-date was their belief that the newly gained information would not be clinically applicable due to a lack of equipment or working in low-economic areas. Patient-related barriers were the major obstacles for participants in implementing evidence-based practice. CONCLUSION Egyptian dentists did not fully embrace minimal invasive approaches for caries management, and practitioners' experiences continue to shape decision-making. It emphasizes the imperative to practically educate dentists using effective knowledge translation dissemination to promote evidence adoption in daily practice and advocate value-based dental care to address the economic crisis's impact on Egypt's healthcare.
Collapse
Affiliation(s)
- Dina M Elkady
- Conservative Department, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Ahmad G A Khater
- Health Affairs Directorate, Egyptian Ministry of Health and Population, Banisuif, 62511, Egypt.
- Faculty of Oral and Dental Medicine, Ahram Canadian University, Giza, Egypt.
| |
Collapse
|
3
|
Bhatia S, Mohanty V, Balappanavar AY, Chahar P, Rijhwani K, Gupta R. Health technology assessment for oral health in the past decade: a scoping review. Int J Technol Assess Health Care 2023; 39:e18. [PMID: 36971267 DOI: 10.1017/s0266462322003312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Health technology assessment (HTA) is the systematic evaluation of various properties and effects of a health technology. HTA can serve as a bridge between the world of knowledge and that of decision making, offering decision makers the best summary of scientific evidence. Scoping HTA reports in the context of dentistry can help researchers identify grey areas; help practitioners make evidence-based decisions and further initiate better policy making. AIM To provide an overview on HTAs pertaining to oral health and dentistry in the past decade, map the extension and scope of the methodological practices, key findings, and limitations. METHODOLOGY A scoping review was conducted using the Joanna Briggs Institute framework. A comprehensive search for HTA reports was done through the International Network of Agencies for Health Technology Assessment Database from January 2010 to December 2020. Consecutively, electronic databases (PubMed and Google Scholar) were searched. Finally, thirty-six reports were included in this review and analyzed. RESULTS A total of 709 articles were initially identified, of which thirty-six met the inclusion criteria. Reviewed HTAs focused on various specialties of dentistry worldwide. Maximum number of reports (N = 5) were related to "prosthodontics and dental implants" and technologies related to preventive dentistry were most commonly assessed (N = 4). CONCLUSION Functional, appropriate, and evidence-based information provided through HTA pertaining to oral health on a regular basis will enable decision makers to have enough data to make decisions on the future use of new technology, modify existing policies, accelerate its translation into practice, and ensure provision of robust dental healthcare services.
Collapse
Affiliation(s)
- Sonal Bhatia
- Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Vikrant Mohanty
- Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
- National Resource Centre for Oral Health and Tobacco Cessation, NOHP, MoHFW, GoI, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Aswini Y Balappanavar
- Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Puneet Chahar
- Monitoring and Evaluation, Tobacco Control Unit, International Union Against Tuberculosis and Lung Diseases, South-East Asia Office, New Delhi, India
| | - Kavita Rijhwani
- Department of Oral Services Research and Dental Public Health, Kings' College, London, UK
| | - Radhika Gupta
- Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
| |
Collapse
|
4
|
Gruß I, Papajorgji-Taylor D, Tommasi NP, Pihlstrom DJ, Hendrickson BP, Ikeda J, Manning W, Madden T, Fellows JL. Dental providers' perceptions of the feasibility and acceptability of implementing vaccine administration programs in dental settings: A qualitative study. J Public Health Dent 2022; 82:330-337. [PMID: 35869664 PMCID: PMC10757238 DOI: 10.1111/jphd.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Involving dental offices in routine vaccinations could have a positive impact on public health. In this study, we assessed dental providers' attitudes and perceptions regarding implementing vaccination in dental settings. METHODS We performed semi-structured interviews with 31 dental providers (25 dentists and 6 dental hygienists) enrolled in the Western region of the National Dental Practice-Based Research Network as of June 28, 2021. Interviews were recorded and transcribed. We analyzed transcripts using deductive and inductive coding approaches. RESULTS We identified three main themes that captured the perceptions of dental practitioners regarding the feasibility of implementing vaccine administration in a dental setting: (1) dental practitioners perceive contributing to the public health mission of disease prevention as having high value, (2) dental practitioners face considerable complexity when deciding whether to implement vaccine administration, and (3) dental practitioners do not understand current laws and associated reimbursement models related to vaccine administration. CONCLUSIONS To make vaccination commonplace in dental practices, legal changes to allow dental practitioners to administer vaccines should be followed by concrete guidance and relevant trainings to help interested dental practitioners successfully implement vaccination programs in their clinical settings.
Collapse
Affiliation(s)
- Inga Gruß
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR, 97227
| | - Dea Papajorgji-Taylor
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR, 97227
| | - Natalia P. Tommasi
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR, 97227
| | | | | | | | | | | | - Jeffrey L. Fellows
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR, 97227
| |
Collapse
|
5
|
Expert view: Shaun Sellars. Br Dent J 2022; 232:627. [PMID: 35562458 DOI: 10.1038/s41415-022-4279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Nassar A, Aboalshamat K, Alharbi R, Alharbi A, Alfozan A, Alahdal S, Aldehri S. The perception of evidence-based dentistry among dental professionals in Saudi Arabia during COVID-19 pandemic. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S99-S105. [PMID: 36110818 PMCID: PMC9469449 DOI: 10.4103/jpbs.jpbs_575_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022] Open
|
7
|
Papakostopoulou M, Kučera J, Tycová H. Understanding orthodontists’ decision making in relation to innovations from encounter to implementation: A qualitative study. Am J Orthod Dentofacial Orthop 2022; 161:e316-e335. [DOI: 10.1016/j.ajodo.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
|
8
|
Leveraging Clinical Decision Support and Integrated Medical-Dental Electronic Health Records to Implementing Precision in Oral Cancer Risk Assessment and Preventive Intervention. J Pers Med 2021; 11:jpm11090832. [PMID: 34575609 PMCID: PMC8470765 DOI: 10.3390/jpm11090832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Precision medicine is focused on serving the unique needs of individuals. Oral and oropharyngeal cancer risk assessment identifies individual risk factors while providing support to reduce risk. The objective is to examine potential current and future strategies to broadly implement evidence-based oral and oropharyngeal cancer risk assessment and screening in dental practices throughout the United States. METHODS Feasible and effective oral cancer risk assessment and risk reduction strategies, ripe for implementation in dental practice, were identified in the published literature. RESULTS The Screening, Brief Intervention, Referral for Treatment (SBIRT) model is a feasible approach to assessing individual oral cancer risk and providing risk reducing interventions in the dental setting. HPV is a more recently identified risk factor that dentistry is well positioned to address. Evidence supporting the utilization of specific risk assessment tools and risk reduction strategies is summarized and future opportunities discussed. DISCUSSION Current knowledge of risk factors for oral and oropharyngeal cancers support the recommendation for dental providers to routinely assess all patients for risk factors, educate them about their personal level of cancer risk, and recommend actions to reduce relevant risk factors. Individuals ages 9-26 should be asked about their HPV vaccination status, educated about HPV and oropharyngeal cancer and receive a recommendation to get the HPV vaccination.
Collapse
|
9
|
How evidence-based is dentistry anyway? From evidence-based dentistry to evidence-based practice. Br Dent J 2020; 229:12-14. [DOI: 10.1038/s41415-020-1785-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Gruß I, Pihlstrom DJ, Kaplan CD, Yosuf N, Fellows JL, Guerrero EG, Polk DE. Stakeholder Assessment of Evidence-Based Guideline Dissemination and Implementation in a Dental Group Practice. JDR Clin Trans Res 2020; 6:87-95. [PMID: 32040925 DOI: 10.1177/2380084420903999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This evaluation captures the perspectives of multiple stakeholders within a salaried dental care delivery organization (dentists, dental assistants, dental hygienists, and dental management) on the implementation of a pit-and-fissure sealant guideline in the Kaiser Permanente Dental Program. Also assessed is the role of formal processes and structures in providing a framework for guideline implementation. METHODS We collected qualitative data through field observations, stakeholder interviews (n = 6), and focus groups (30 participants in 5 focus groups). Field observation notes captured summaries of conversations and other activities. Interviews and focus groups were recorded and transcribed. We analyzed transcripts and field notes using a template analysis with NVivo 12 software to identify themes related to the existing implementation process of clinical guidelines and stakeholder perspectives on the strengths and weaknesses of this process. RESULTS Stakeholders perceived 2 main barriers for achieving implementation of the pit-and-fissure sealant guideline: 1) shortcomings in the implementation infrastructure resulting in lack of clarity about the roles and responsibilities in the guideline implementation process and lack of effective mechanisms to disseminate guideline content and 2) resource constraints, such as limited human, space, and material resources. Perceived opportunities for the dissemination and implementation of guidelines included recognition of the importance of guidelines in dental practice and well-functioning workflows within dental specialties. CONCLUSION Our research points to the importance of developing and maintaining an infrastructure to ensure standardized, predictable mechanisms for implementation of guidelines and thereby promoting practice change. While addressing resource constraints may not be possible in all circumstances, an important step for improving guideline implementation-wherever feasible-would be the development of a robust implementation infrastructure that captures and delineates roles and responsibilities of different clinical actors in the guideline implementation process. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by health care leadership and administrators to understand possible reasons for a lack of guideline implementation and provide suggestions for establishing sustainable infrastructure to promote the adoption of clinical guidelines in salaried dental clinics.
Collapse
Affiliation(s)
- I Gruß
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - C D Kaplan
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - N Yosuf
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - J L Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - E G Guerrero
- I-Lead Institute-Research to End Healthcare Disparities Corp, Santa Monica, CA, USA
| | - D E Polk
- University of Pittsburgh, Pitt Dental Medicine, Pittsburgh, PA, USA
| |
Collapse
|
11
|
Zeola LF, Teixeira DNR, Galvão ADM, Souza PG, Soares PV. Brazilian dentists' perception of dentin hypersensitivity management. Braz Oral Res 2020; 33:e115. [PMID: 31939497 DOI: 10.1590/1807-3107bor-2019.vol33.0115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/05/2019] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate how Brazilian dentists perceive and manage dentin hypersensitivity (DH) in their clinical routine. A 13-item questionnaire-based survey was developed and sent electronically to a convenience sample of dentists. The questionnaire assessed the personal and dental practice characteristics of the sample, the occurrence of DH in their daily clinical practice, and management strategies. The data were analyzed descriptively and together with the chi-square test (a = 0.05). A total of 353 responses were obtained from September 2017 to March 2018. Of all the respondents, 62% were females, 49.9% reported fewer than five years of dental practice, and 70.5% were self-identified as private practitioners. Most of the dentists reported an estimated frequency (30-60%) of patients with DH in their practice. The most frequently cited (91.79%) trigger of DH was air blast and/or scratching with a probe. The first-choice strategy to manage DH was a dentin desensitizer (48.16%). The number of years in clinical practice did not influence DH relapse frequency (p = 0.76) significantly, or consider DH treatment as a problem (p = 0.22). The present findings indicate that, regardless of clinical experience, dentists in Brazil still consider DH management a challenge in their daily dental practice. In addition, the results suggest that guidelines should be developed to disseminate the available knowledge regarding this condition in ways that may influence decision-making processes among practitioners.
Collapse
Affiliation(s)
- Livia Fávaro Zeola
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlandia, MG, Brazil
| | - Daniela Navarro Ribeiro Teixeira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlandia, MG, Brazil
| | - Alexia da Mata Galvão
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlandia, MG, Brazil
| | - Paola Gomes Souza
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlandia, MG, Brazil
| | - Paulo Vinícius Soares
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlandia, MG, Brazil
| |
Collapse
|
12
|
Abstract
Academic leaders are responsible for a generation of evidence. They must understand research and its synthesis. One of their priorities should be to reduce waste in dental research and improve value by conducting less research, better research and research for the right reasons. This requires the ability to adapt to change, to work collaboratively, as well as having the vision and courage to be innovative when meeting the challenges of improving oral health worldwide in an evidence-based way.
Collapse
Affiliation(s)
- Janet Clarkson
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, Scotland, UK; Cochrane Oral Health, School of Dentistry, University of Manchester, Manchester, UK; NHS Education for Scotland, Dundee Dental Education Centre, Dundee, Scotland, UK.
| | - Helen Worthington
- Cochrane Oral Health, School of Dentistry, University of Manchester, Manchester, UK
| |
Collapse
|
13
|
Salehi-Marzijarani M, Ayatollahi SMT, Pourahmad S, Zare M, Peymani P. Network Clustering and Bibliometrics of Pharmacology and Pharmacy Research Outputs Published by Iranian Authors. J Res Pharm Pract 2019; 8:13-19. [PMID: 30911558 PMCID: PMC6400032 DOI: 10.4103/jrpp.jrpp_18_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Evidence-based practice in medical sciences needs to publish confidential evidence that strongly depends on the research publications. This bibliometrics and network analytic study aims to evaluate the research publications of Iranian authors in pharmacology and pharmacy. Methods: Through the pharmacology and pharmacy category of Web of Science (WOS), all published articles affiliated with an Iranian researcher as an author were retrieved. Full records of retrieved articles in the WOS, including author name and affiliation, journal name, citation number, cited references, and keywords, were exported to a plain text file. Network analysis through VOSviewer was used for mapping the characteristics of the retrieved articles. All statistical analyses were done using the Microsoft Excel and SPSS version 25. Findings: The total number of Iran's publications (citations) rose from 1557 articles (10,085 citations) in 2000–2009 years to 6271 articles (77791 citations) in 2010–2018 years. Tehran University of Medical Sciences was the most productive university. The total number of RCTs rose from 82 publications in 2000–2009 to 278 publications in 2010–2018. The same numbers for systematic reviews and meta-analyses were four publications in 2000–2009 and 169 publications in 2010–2018. The five major topics of researches in pharmacology and pharmacy were drug delivery, basic pharmacology, oxidative stress, animal study, and molecular aspect of pharmacy. Conclusion: This study showed a marked increasing rate of publications and received citations by Iranians in pharmacology and pharmacy. After 2010, the rate of articles in the high-impact journals had growth. Furthermore, research articles in the highest level of evidence were more published by Iranians.
Collapse
Affiliation(s)
| | | | - Saeedeh Pourahmad
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Marziyeh Zare
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Payam Peymani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| |
Collapse
|
14
|
Abstract
The primary objective of evidence-based practice is to improve the quality of health care. It helps in making a clinical decision based on recent and advanced research and the best available evidence. Evidence-based dentistry is an integration of best available evidence with clinical expertise and patient’s needs and preferences. However, there are many barriers to apply evidence-based knowledge into practice. Information overflow, inability to select appropriate evidence, and critically appraising the evidence are the main challenges a practitioner may face. The focus of this review is defining a well-structured clinical question, key principles of literature search, type of search studies, and how to appraise an evidence. Furthermore, despite the availability of good evidence, patient’s needs and preferences are crucial factors in making clinical decision. Finally, the clinician’s experience and lack of motivation to change practice is another big challenge to evidence-based practice. This article discusses the six structured steps to apply evidence-based practice in dentistry with examples. Finally, this article will help practitioners to integrate their experience and skill with modern research evidence as well as to educate their patients to reach a final clinical decision.
Collapse
Affiliation(s)
- Durr-E-Sadaf
- Conservative Dentistry Department, College of Dentistry, Qassim University, Qassim, Saudi Arabia, .,Evidence Based Healthcare, Centre of Evidence Based Medicine, University of Oxford, Oxford, UK,
| |
Collapse
|
15
|
Gonçalves APR, Correa MB, Nahsan FPS, Soares CJ, Moraes RR. Use of scientific evidence by dentists in Brazil: Room for improving the evidence-based practice. PLoS One 2018; 13:e0203284. [PMID: 30231035 PMCID: PMC6145584 DOI: 10.1371/journal.pone.0203284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022] Open
Abstract
This study investigated the use of scientific evidence and the practice of evidence-based dentistry (EBD) among dentists working in Brazil. An online questionnaire was emailed to dentists registered with Brazilian state dental councils. The questionnaire assessed the demographic, educational, and work characteristics of the sample, along with habits in reading scientific articles and other updating resources. Data were analyzed descriptively and by using Bonferroni, Kruskal-Wallis, ANOVA, and T-test statistical methods (α = 0.05). A total of 795 responses were received between June, 2015 and January, 2016. The response rate was not calculated because it was not possible to determine precisely how many dentists received these e-mails. Over 77% of the responding dentists completed postgraduate training. They referred mainly to books, scientific or clinical journals, conferences, and short-term courses for updating their knowledge. Dentists who reported having a habit of reading scientific journals (60.9%) showed a preference for reading case reports, clinical research articles, and literature reviews. Most dentists (77.5%) reported changing their clinical behaviors or procedures based on information gleaned from journal articles. The types of articles that led them to change their clinical practices were primarily clinical research articles and case reports. Working in the public sector was also associated with a lower prevalence of a habit of reading scientific journals and practicing EBD (i.e., self-reported practice). The results suggest that dentists are interested in reading journal articles, especially those addressing clinical outcomes, and that there is room for improving the practice of EBD, particularly in the public sector.
Collapse
Affiliation(s)
| | - Marcos B. Correa
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Flavia P. S. Nahsan
- Graduate Program in Dentistry, Federal University of Sergipe, Aracaju, SE, Brazil
| | - Carlos J. Soares
- Graduate Program in Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Rafael R. Moraes
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
- * E-mail:
| |
Collapse
|
16
|
Alexander G, Hopcraft MS, Tyas MJ, Wong RHK. Dentists' restorative decision-making and implications for an ‘amalgamless’ profession. Part 5: knowledge factors. Aust Dent J 2017; 62:440-452. [DOI: 10.1111/adj.12533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 12/30/2022]
Affiliation(s)
- G Alexander
- Melbourne Dental School; University of Melbourne; Melbourne Victoria Australia
- Department of Dentistry and Oral Health; La Trobe University; Melbourne Victoria Australia
| | - MS Hopcraft
- Melbourne Dental School; University of Melbourne; Melbourne Victoria Australia
| | - MJ Tyas
- Melbourne Dental School; University of Melbourne; Melbourne Victoria Australia
| | - RHK Wong
- Melbourne Dental School; University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
17
|
Afrashtehfar KI, Assery MK. From dental science to clinical practice: Knowledge translation and evidence-based dentistry principles. Saudi Dent J 2017; 29:83-92. [PMID: 28725125 PMCID: PMC5503095 DOI: 10.1016/j.sdentj.2017.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 02/12/2017] [Indexed: 01/07/2023] Open
Abstract
It has been claimed that in order to decrease the gap between what we know and what we do, research findings must be translated from knowledge to action. Such practices better enable dentists to make evidence-based decisions instead of personal ideas and judgments. To this end, this literature review aims to revisit the concepts of knowledge translation and evidence-based dentistry (EBD) and depict their role and influence within dental education. It addresses some possible strategies to facilitate knowledge translation (KT), encourage dental students to use EBD principles, and to encourage dental educators to create an environment in which students become self-directed learners. It concludes with a call to develop up-to-date and efficient online platforms that could grant dentists better access to EBD sources in order to more efficiently translate research evidence into the clinic.
Collapse
Affiliation(s)
- Kelvin I. Afrashtehfar
- Department for Reconstructive Dentistry & Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Oral Health & Research Division, Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Corresponding author at: Department of Reconstructive Dentistry & Gerodontology, School of Dental Medicine, Faculty of Medicine, University of Bern, Rm C305, Freiburgstrasse 7, CH-3010 Bern, Berne, Switzerland. Fax: +41 31 632 49 33.Department of Reconstructive Dentistry & GerodontologySchool of Dental MedicineFaculty of MedicineUniversity of BernRm C305, Freiburgstrasse 7CH-3010 BernBerneSwitzerland
| | - Mansour K. Assery
- Deanship for Post Graduate and Scientific Research, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
| |
Collapse
|
18
|
Affiliation(s)
- Vineet Dhar
- Division Chief/Graduate Program Director, Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, MD, USA. E-mail:
| |
Collapse
|
19
|
Polk DE, Nolan BA, Shah NH, Weyant RJ. Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.1.tb06054.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Beth A.D. Nolan
- University of Pittsburgh Graduate School of Public Health at the time of this study
| | | | | |
Collapse
|
20
|
Dragan IF, Newman M, Stark P, Steffensen B, Karimbux N. Using a Simulated Infobutton Linked to an Evidence-Based Resource to Research Drug-Drug Interactions: A Pilot Study with Third-Year Dental Students. J Dent Educ 2015. [DOI: 10.1002/j.0022-0337.2015.79.11.tb06032.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Irina F. Dragan
- Department of Periodontology; Tufts University School of Dental Medicine
| | - Michael Newman
- University of California; Los Angeles School of Dentistry
| | - Paul Stark
- Tufts University School of Dental Medicine
| | - Bjorn Steffensen
- Department of Periodontology; Tufts University School of Dental Medicine
| | | |
Collapse
|
21
|
Yesudian GT, Gilchrist F, Bebb K, Albadri S, Aspinall A, Swales K, Deery C. A multicentre, multicycle audit of the prescribing practices of three paediatric dental departments in the North of England. Br Dent J 2015; 218:681-5. [DOI: 10.1038/sj.bdj.2015.440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/09/2022]
|
22
|
Yamalik N, Nemli SK, Carrilho E, Dianiskova S, Melo P, Lella A, Trouillet J, Margvelashvili V. Implementation of evidence-based dentistry into practice: analysis of awareness, perceptions and attitudes of dentists in the World Dental Federation–European Regional Organization zone. Int Dent J 2015; 65:127-45. [DOI: 10.1111/idj.12160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
23
|
Alexander G, Hopcraft MS, Tyas MJ, Wong RHK. Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 1: a review. Aust Dent J 2014; 59:408-19. [PMID: 25090909 DOI: 10.1111/adj.12209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 11/27/2022]
Abstract
The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence-based decision-making, minimally invasive approaches, and approaches to education. The implications for these in an 'amalgamless' profession are identified.
Collapse
Affiliation(s)
- G Alexander
- Melbourne Dental School, The University of Melbourne, Victoria; Department of Dentistry and Oral Health, La Trobe University, Victoria
| | | | | | | |
Collapse
|
24
|
Alexander G, Hopcraft MS, Tyas MJ, Wong RHK. Dentists' restorative decision-making and implications for an ‘amalgamless’ profession. Part 2: a qualitative study. Aust Dent J 2014; 59:420-31. [DOI: 10.1111/adj.12212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- G Alexander
- Melbourne Dental School; The University of Melbourne; Victoria
- Department of Dentistry and Oral Health; La Trobe University; Victoria
| | - MS Hopcraft
- Melbourne Dental School; The University of Melbourne; Victoria
| | - MJ Tyas
- Melbourne Dental School; The University of Melbourne; Victoria
| | - RHK Wong
- Melbourne Dental School; The University of Melbourne; Victoria
| |
Collapse
|
25
|
Kao RT, Nares S, Reynolds MA. Periodontal regeneration - intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2014; 86:S77-104. [PMID: 25216204 DOI: 10.1902/jop.2015.130685] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous systematic reviews of periodontal regeneration with bone replacement grafts and guided tissue regeneration (GTR) were defined as state of the art for clinical periodontal regeneration as of 2002. METHODS The purpose of this systematic review is to update those consensus reports by reviewing periodontal regeneration approaches developed for the correction of intrabony defects with the focus on patient-, tooth-, and site-centered factors, surgical approaches, surgical determinants, and biologics. This review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews. A computerized search of the PubMed and Cochrane databases was performed to evaluate the clinically available regenerative approaches for intrabony defects. The search included screening of original reports, review articles, and reference lists of retrieved articles and hand searches of selected journals. All searches were focused on clinically available regenerative approaches with histologic evidence of periodontal regeneration in humans published in English. For topics in which the literature is lacking, non-randomized observational and experimental animal model studies were used. Therapeutic endpoints examined included changes in clinical attachment level, changes in bone level/fill, and probing depth. For purposes of analysis, change in bone fill was used as the primary outcome measure, except in cases in which this information was not available. The SORT (Strength of Recommendation Taxonomy) grading scale was used in evaluating the body of knowledge. RESULTS 1) Fifty-eight studies provided data on patient, tooth, and surgical-site considerations in the treatment of intrabony defects. 2) Forty-five controlled studies provided outcome analysis on the use of biologics for the treatment of intrabony defects. CONCLUSIONS 1) Biologics (enamel matrix derivative and recombinant human platelet-derived growth factor-BB plus β-tricalcium phosphate) are generally comparable with demineralized freeze-dried bone allograft and GTR and superior to open flap debridement procedures in improving clinical parameters in the treatment of intrabony defects. 2) Histologic evidence of regeneration has been demonstrated with laser therapy; however, data are limited on clinical predictability and effectiveness. 3) Clinical outcomes appear most appreciably influenced by patient behaviors and surgical approach rather than by tooth and defect characteristics. 4) Long-term studies indicate that improvements in clinical parameters are maintainable up to 10 years, even in severely compromised teeth, consistent with a favorable/good long-term prognosis.
Collapse
|
26
|
Fox C, Kay EJ, Anderson R. Evidence-based dentistry – overcoming the challenges for the UK's dental practitioners. Br Dent J 2014; 217:191-4. [DOI: 10.1038/sj.bdj.2014.703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/09/2022]
|
27
|
Teich ST, Demko CA, Lang LA. Evidence-Based Dentistry and Clinical Implementation by Third-Year Dental Students. J Dent Educ 2013. [DOI: 10.1002/j.0022-0337.2013.77.10.tb05602.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sorin T. Teich
- Department of Comprehensive Care; Case Western Reserve University School of Dental Medicine
| | - Catherine A. Demko
- Department of Community Dentistry; Case Western Reserve University School of Dental Medicine
| | - Lisa A. Lang
- Department of Comprehensive Care; Case Western Reserve University School of Dental Medicine
| |
Collapse
|
28
|
Sbaraini A, Carter SM, Evans RW, Blinkhorn A. How do dentists and their teams incorporate evidence about preventive care? An empirical study. Community Dent Oral Epidemiol 2013; 41:401-14. [PMID: 23356457 DOI: 10.1111/cdoe.12033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 12/10/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify how dentists and their teams adopt evidence-based preventive care. METHODS A qualitative study using grounded theory methodology was conducted. We interviewed 23 participants working in eight dental practices about their experience and work processes, while adopting evidence-based preventive care. During the study, Charmaz's grounded theory methodology was employed to examine the social process of adopting preventive dental care in dental practices. Charmaz's iteration of the constant comparative method was used during the data analysis. This involved coding of interview transcripts, detailed memo-writing and drawing diagrams. The transcripts were analyzed as soon as possible after each round of interviews in each dental practice. Coding was conducted primarily by AS, supported by team meetings and discussions when researchers compared their interpretations. RESULTS Participants engaged in a slow process of adapting evidence-based protocols and guidelines to the existing logistics of the practices. This process was influenced by practical, philosophical, and historical aspects of dental care, and a range of barriers and facilitators. In particular, dentists spoke spontaneously about two deeply held 'rules' underpinning continued restorative treatment, which acted as barriers to provide preventive care: (i) dentists believed that some patients were too 'unreliable' to benefit from prevention; and (ii) dentists believed that patients thought that only tangible restorative treatment offered 'value for money'. During the adaptation process, some dentists and teams transitioned from their initial state - selling restorative care - through an intermediary stage - learning by doing and educating patients about the importance of preventive care - and finally to a stage where they were offering patients more than just restorative care. Resources were needed for the adaptation process to occur, including: the ability to maintain the financial viability of the practice, appropriate technology, time, and supportive dental team relationships. CONCLUSIONS The findings from this study show that with considerable effort, motivation and coordination, it is possible for dental practices to work against the dental 'mainstream' and implement prevention as their clinical norm. This study has shown that dental practice is not purely scientific, but it includes cultural, social, and economic resources that interfere with the provision of preventive care.
Collapse
Affiliation(s)
- Alexandra Sbaraini
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, NSW, Australia; Population Oral Health, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia
| | | | | | | |
Collapse
|
29
|
Best AM, Laskin DM. Oral and Maxillofacial Surgery Residents Have Poor Understanding of Biostatistics. J Oral Maxillofac Surg 2013; 71:227-34. [DOI: 10.1016/j.joms.2012.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/15/2012] [Accepted: 03/17/2012] [Indexed: 10/28/2022]
|
30
|
Donos N, Laurell L, Mardas N. Hierarchical decisions on teeth vs. implants in the periodontitis-susceptible patient: the modern dilemma. Periodontol 2000 2012; 59:89-110. [PMID: 22507062 DOI: 10.1111/j.1600-0757.2011.00433.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is estimated that advanced periodontitis typically affects about 10% of most adult populations studied. These individuals can be considered highly susceptible to periodontitis and often present difficulties for clinicians in therapeutic decision making, especially when dental implants are involved. Poor plaque control and smoking are well established risk factors for periodontitis, as well as for peri-implant disease. Long-term follow-up studies have clearly demonstrated that treatment of periodontal disease, even if advanced, can be successful in arresting disease progression and preventing (or at least significantly delaying) tooth loss. With the increasing development of implant dentistry, traditional well documented and evidence-based therapies to treat periodontal diseases may sometimes not be used to their full potential. Instead, there appears to be an increasing tendency to extract periodontally compromised teeth and replace them with implants, as if implants can solve the problem. However, peri-implant diseases are prevalent, affecting between 28% and 56% of people with implants, and (at the implant level) 12-43% of implants. A history of periodontal disease, smoking and poor oral hygiene are all risk factors for developing peri-implantitis. Unlike periodontitis, there are currently no predictable means for treating peri-implantitis, although resective surgery seems to be the most effective technique. Consequently, if implant treatment is considered in patients who are susceptible to periodontitis, it should be preceded by appropriate and adequate periodontal treatment or re-treatment to control the condition, and should be followed by a stringent supportive maintenance program to prevent the development of peri-implant disease. The decision whether implant treatment should be performed should be based on an assessment of the patient's risk profile at the subject level, as well as at the site level.
Collapse
|
31
|
Spallek H, Song M, Polk DE, Bekhuis T, Frantsve-Hawley J, Aravamudhan K. Barriers to implementing evidence-based clinical guidelines: a survey of early adopters. J Evid Based Dent Pract 2010; 10:195-206. [PMID: 21093800 PMCID: PMC3011934 DOI: 10.1016/j.jebdp.2010.05.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 05/28/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. METHOD This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. RESULTS The most common barriers to implementation were difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems had to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. CONCLUSIONS Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists' fears need to be addressed.
Collapse
Affiliation(s)
- Heiko Spallek
- Center for Dental Informatics, Department of Dental Public Health and Information Management, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.
| | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Kikwilu EN, Frencken J, Mulder J. Impact of Atraumatic Restorative Treatment (ART) on the treatment profile in pilot government dental clinics in Tanzania. BMC Oral Health 2009; 9:14. [PMID: 19505294 PMCID: PMC2702271 DOI: 10.1186/1472-6831-9-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 06/08/2009] [Indexed: 02/08/2023] Open
Abstract
Background The predominant mode of treatment in government dental clinics in Tanzania has been tooth extraction because the economy could not support the conventional restorative care which depends on expensive equipment, electricity and piped water systems. Atraumatic Restorative Treatment (ART) was perceived as a suitable alternative. A 3.5-year study was designed to document the changes in the treatment profiles ascribed to the systematic introduction of ART in pilot government dental clinics. Methods Dental practitioners who were working in 13 government dental clinics underwent a 7-day ART training. Treatment record data on teeth extracted and teeth restored by the conventional and ART approaches were collected from these clinics for the three study periods. The mean percentage of ART restorations to total treatment, ART restorations to total restorations, and total restorations to total treatments rendered were computed. Differences between variables were determined by ANOVA, t-test and Chi-square. Results The mean percentage of ART restorations to total treatment rendered was 0.4 (SE = 0.5) and 11.9 (SE = 1.1) during the baseline and second follow-up period respectively (ANOVA mixed model; P < 0.0001). The mean percentage of ART restorations to total restorations rendered at baseline and 2nd follow-up period was 8.4% and 88.9% respectively (ANOVA mixed model; P < 0.0001). The mean percentage of restorations to total treatment rendered at baseline and 2nd follow-up was 3.9% and 13.0%, respectively (ANOVA mixed model; P < 0.0001). Ninety-nine percent of patients were satisfied with ART restorations, 96.6% willing to receive ART restoration again in future, and 94.9% willing to recommend ART treatment to their close relatives. Conclusion ART introduction in pilot government dental clinics raised the number of teeth saved by restorative care. Countrywide introduction of the ART approach in Tanzania is recommended.
Collapse
Affiliation(s)
- Emil Namakuka Kikwilu
- Department of Preventive and Community Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sciences, P,O, Box 65014, Dar es Salaam, Tanzania.
| | | | | |
Collapse
|
34
|
|
35
|
Baelum V. Caries management: technical solutions to biological problems or evidence-based care? J Oral Rehabil 2007; 35:135-51. [PMID: 18197847 DOI: 10.1111/j.1365-2842.2007.01784.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Caries-related clinical decision-making remains a centrepiece of clinical dentistry. However, the oral disease patterns are rapidly changing towards the better among major sections of the populations, most notably in the high-income countries. The caries decline is well documented among children and younger adults, and is gradually seen to trickle into middle and old age as well. Although it is tempting for the dental profession to take the credit for this development, the evidence points in a different direction. The major contribution of dentistry seems primarily related to changes in the treatment philosophies towards a less interventionist approach. This review aims to spur a further change in the diagnostic and treatment criteria used in the management of dental caries for the benefit of the oral health status of our patients. We must come to terms with the fact that our traditional core skills, our manual dexterity and technical competence, have less to offer to oral health than we have been accustomed to think. The dental schools and the professional dental organizations must carry the responsibility for promoting the necessary changes in the caries related clinical decision-making strategies to allow practicing dentists to provide appropriate oral health care to our populations.
Collapse
Affiliation(s)
- V Baelum
- Department of Community Oral Health and Pediatric Dentistry, School of Dentistry, Faculty of Health Sciences, University of Aarhus, Aarhus C, Denmark.
| |
Collapse
|